At times, in medicine, you feel you are inside a colossal and impossibly complex machine whose gears will turn for you only according to their own arbitrary rhythm. The notion that human caring, the effort to do better for people, might make a difference can seem hopelessly naive. But it isn't.

What about regular professionals, who just want to do what they do as well as they can?

This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.

Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work - whether in healthcare, education, climate change, making a pathway out of poverty - is the great task of our generation as a whole.

In every industrialized nation, the movement to reform health care has begun with stories about cruelty.

Are doctors who make mistakes villains? No, because then we all are.

Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.